Systematic review of wastewater surveillance of antimicrobial resistance in human populations

Chau, K.K.; Barker, L.; Budgell, E.P.; Vihta, K.D.; Sims, N.; Kasprzyk-Hordern, B.; Harriss, E.; Crook, D.W.; Read, D.S. ORCID: https://orcid.org/0000-0001-8546-5154; Walker, A.S.; Stoesser, N.. 2022 Systematic review of wastewater surveillance of antimicrobial resistance in human populations. Environment International, 162, 107171. 12, pp. 10.1016/j.envint.2022.107171

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Official URL: http://dx.doi.org/10.1016/j.envint.2022.107171

Abstract/Summary

Objectives: We systematically reviewed studies using wastewater for AMR surveillance in human populations, to determine: (i) evidence of concordance between wastewater-human AMR prevalence estimates, and (ii) methodological approaches which optimised identifying such an association, and which could be recommended as standard. We used Lin’s concordance correlation coefficient (CCC) to quantify concordance between AMR prevalence estimates in wastewater and human compartments (where CCC = 1 reflects perfect concordance), and logistic regression to identify study features (e.g. sampling methods) associated with high agreement studies (defined as >70% of within-study wastewater-human AMR prevalence comparisons within ±10%). Results: Of 8,867 records and 441 full-text methods reviewed, 33 studies were included. AMR prevalence data was extractable from 24 studies conducting phenotypic-only (n = 7), genotypic-only (n = 1) or combined (n = 16) AMR detection. Overall concordance of wastewater-human AMR prevalence estimates was reasonably high for both phenotypic (CCC = 0.85 [95% CI 0.8–0.89]) and genotypic approaches (CCC = 0.88 (95% CI 0.84–0.9)) despite diverse study designs, bacterial species investigated and phenotypic/genotypic targets. No significant relationships between methodological approaches and high agreement studies were identified using logistic regression; however, this was limited by inconsistent reporting of study features, significant heterogeneity in approaches and limited sample size. Based on a secondary, descriptive synthesis, studies conducting composite sampling of wastewater influent, longitudinal sampling >12 months, and time-/location-matched sampling of wastewater and human compartments generally had higher agreement. Conclusion: Wastewater-based surveillance of AMR appears promising, with high overall concordance between wastewater and human AMR prevalence estimates in studies irrespective of heterogenous approaches. However, our review suggests future work would benefit from: time-/location-matched sampling of wastewater and human populations, composite sampling of influent, and sampling >12 months for longitudinal studies. Further research and clear and consistent reporting of study methods is required to identify optimal practice.

Item Type:	Publication - Article
Digital Object Identifier (DOI):	10.1016/j.envint.2022.107171
UKCEH and CEH Sections/Science Areas:	Soils and Land Use (Science Area 2017-)
ISSN:	0160-4120
Additional Information. Not used in RCUK Gateway to Research.:	Open Access paper - full text available via Official URL link.
Additional Keywords:	AST, antimicrobial susceptibility testing, CIA, critically important antimicrobial, ESBL, extended spectrum beta-lactamase, IQR, interquartile range, LMIC, lower-middle-income country, MDR, multidrug resistant, PE, population equivalent, WGS, whole genome sequencing, WWTW, wastewater treatment works
NORA Subject Terms:	Health Biology and Microbiology
Date made live:	06 Apr 2022 15:14 +0 (UTC)
URI:	https://nora.nerc.ac.uk/id/eprint/532428

Item Type:

Publication - Article

Digital Object Identifier (DOI):

10.1016/j.envint.2022.107171

UKCEH and CEH Sections/Science Areas:

Soils and Land Use (Science Area 2017-)

ISSN:

0160-4120

Additional Information. Not used in RCUK Gateway to Research.:

Open Access paper - full text available via Official URL link.

Additional Keywords:

AST, antimicrobial susceptibility testing, CIA, critically important antimicrobial, ESBL, extended spectrum beta-lactamase, IQR, interquartile range, LMIC, lower-middle-income country, MDR, multidrug resistant, PE, population equivalent, WGS, whole genome sequencing, WWTW, wastewater treatment works

NORA Subject Terms:

Health
Biology and Microbiology

Date made live:

06 Apr 2022 15:14 +0 (UTC)

URI:

https://nora.nerc.ac.uk/id/eprint/532428